Program Operations Manual System (POMS)

HI 00825.120 Telephone Calls

Telephone calls received by the Exceptions surance and Inquiries Examiner will usually be of a sensitive nature when initiated from an SSA entity or other Government agency. Other calls of a less sensitive nature but which pertain to problems on individual cases may also be received. These must be handled as promptly as possible but not at the expense of the truly sensitive inquiries. Determine the urgency of the issue from the caller and assign priorities on that basis. Telephone calls from the public or their representatives which are received by the Inquiry and Expediting Staff and which pertain to a critical or sensitive HI/SMI issue will also be referred to the Exceptions and Inquiries Examiner (on a written report) for control in resolving the problem.

Telephone calls from OURV Critical Case Specialists, the Office of Public Inquiries, and any other Central Office component must be given priority attention. When a HI/SMI situation has reached the point that the SSA Central Office must get involved, it is usually because a beneficiary has not been able to obtain a satisfactory solution from a local district office or program service center. The service the beneficiary or representative receives at this point will no doubt leave a lasting impression of the Social Security Administration.

The following processing steps must be followed:

A “phone call record of critical HI/SMI issue” (see HI 00825.905 at the end of this subchapter) should be completed in duplicate. If action other than that by the Exceptions and Inquiries Examiner is required, attach the original phone call record to the claims folder and maintain the duplicate in a control file for return of the claims folder within 3 days.

Social Security numbers for normally sensitive inquiries should be accumulated and once or twice each day the Records Analysis Clerk should be requested to obtain and deliver the claims folder immediately. If any folder is not available in the merged files, a priority hold should immediately be placed on the folder using the RSI Case Control System.

If the caller states that the case involved is of an extremely critical nature and must have information immediately, obtain the desired folder at once. If the folder is not in the merged files, request the Records Analysis Clerk to place a priority hold on the folder using the RSI Case Control System. This procedure must always be used for all calls from the OURV Critical Case Specialist or the Office of Public Inquiries at Central Office. If there will be any delay in answering an extremely critical case, immediately furnish the reason for the delay to the caller.

All phone call inquiries which can be processed by the Exceptions and Inquiries Examiner should have all actions completed within 1 day of receipt of the call. Control any phone inquiry requiring processing outside of the module for return in 3 days. If not returned within this time frame, query the RSI Case Control System and call the location of the folder requesting a special search and immediate processing. If immediate processing is not possible due to development, etc., determine when the action is expected to be completed and follow up at that time.

After all actions have been completed, file the original telephone report in the folder and destroy the duplicate report.